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Psychotherapy for Obsessive Compulsive Disorder by Paul Lohkamp, MSW, LCSW 


Before 1965, obsessive-compulsive disorder  (OCD) was thought to be untreatable.   Now it is known to be very treatable, but not with a generic or general psychotherapy approach.  Because of its complexities, the poor insight of many sufferers and the high incidence of other complications, advanced training and experience are needed.  Following is some information about what to look for in the treatment of OCD: 

First of all, a comprehensive OCD assessment is essential and needs to include a level of care evaluation.  This includes a personal and family history, followed by an inventory of symptoms and their severity.  The therapist should be familiar with the Yale Brown Obsessive Compulsive Scale (Y-BOCS) and the severity rating and be able to administer them proficiently.   The assessor needs to be skillful in helping the client identify key symptoms, determining readiness for therapy, and educating the client about behavior therapy.   Helping the client complete a hierarchy of avoidance and exposure practice goals is often complicated and painstakingly difficult.  In addition, many sufferers have depression, serious relationship issues or other complications that must be managed before behavior therapy can be effective. 

Secondly, some OCD patients do not fit into the box of once a week, fifty-minute session, office practice of psychotherapy.  The therapist needs to be willing to go to the client, if necessary, and to offer a variety of ways to do behavior therapy. Family involvement is also very important.  Sometimes the client will need to be referred to residential or intensive outpatient treatment.  Other clients will need in depth work with the family to get ready for treatment.  In addition, the therapist must be skilled in working with insurance companies to get more frequent or intensive therapy covered.  For example, some clients may need several hours of therapy in one day, instead of the traditional 50-minute interview.

Optimal treatment for most people with OCD involves the combination of medication plus the behavior therapy techniques of exposure and response prevention (E/RP).  A personís primary physician will often perscribe the important medication, an ďSSRIĒ antidepressant.   Often a referral to a Psychiatrist is needed.  Finding a therapist or counselor skilled in E/RP is another issue.   

When you are looking for a therapist, it is important to be ready with information and questions that can help determine if a therapist is indeed competent and experienced with OCD. To gather information on this subject, see Dr. Lee Baer's book "Getting Control," or check out articles on the Obsessive Compulsive Foundationís website (see )  Following are some general guidelines for selecting a behavior therapist: 

Guidelines for selecting a behavior therapist for OCD.,

If you have any questions about OCD or about finding a behavior therapist, donít hesitate to call Paul Lohkamp  at Phone 314 837-2050, or email

See Paul's Website at

Web www.Psychtreatment.Com
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